AORTA

AORTA is the Dutch nationwide infrastructure for the exchange of data between healthcare providers. AORTA uses HL7 version 3 messages and documents as its core mechanism for information exchange. The initial specifications have been created in 2003.

The Dutch Ministry of Health, Welfare and Sport is working on a nationwide EHR system which will enable healthcare providers to share patient data. This development takes place in close collaboration with NICTIZ, the National IT institute for Healthcare.

The first two implementation areas of this Electronic Health Record are an electronic medication record (known by its Dutch acronym as: EMD) and en electronic general practitioner’s summary file to be used by locum GP’s (WDH). Right now, these two implementation areas are being piloted in a total of 12 regions. The aim is to start a production rollout for these two implementation areas from January 1st 2007.

The structure of healthcare in the Netherlands is based on loosely integrated healthcare providers, and a partly-socialised healthcare insurance system. Each inhabitant of the Netherlands will typically have a nominated general practitioner (G.P.). If necessary the G.P. will refer the patient to a secondary care facility (typically a hospital, none of which are private). Prescriptions can be dispensed by any pharmacy.

In order to provide safe and reliable electronic communications, it is necessary for patients and healthcare professionals to electronically identify themselves. For patient identification, everyone in the Netherlands will be issued a Citizen Service Number (BSN). The introduction of this identification scheme (by the Ministry of the Interior and Kingdom Relations) is pending legislation which is likely to be adopted in 2006. The BSN identifiers are already being used in the AORTA pilot regions.

Healthcare providers will be provided with an Unique Healthcare provider Identification chipcard (known as the UZI card, see the www.uzi-register.nl Website). Usage of BSN and UZI will be mandatory when electronically exchanging patient data.

For a 10 minute high-level overview of the architecture (in English), see the Windows Media video or the Apple Quicktime video. These are aimed at healthcare providers and as such don't mention HL7.

Architecture

Communication between applications in a hospital setting is almost exclusively based on HL7 version 2.

Dutch and European privacy laws don’t allow for centralized collections of healthcare data – which means data has to be stored in the application of the responsible author, and not in a centralized database.

AORTA Projects

Next to the infrastructural components as described in the Architecture section, a number of clinical domains have been analyzed and documented.

NICTIZ has done (or: is in the process of doing) analysis of a number of clinical domains:

• WDH: Allows a Locum GP (mostly when out of hours services are being provided) to get hold of a summary from the patient's GP, and supports the transmission of performed Locum GP services to the patient's regular GP.
• EMD: Supports the process of prescribing and supplying medication, and the querying of a medication registry for historical precriptions and supply activities.
  • Note: Even prior to the creation of a national infrastructure the prescription process is automated to a certain extent. G.P.s and community pharmacies were amongst the first to understand the importance of computerized information and the use of personal computers has been introduced with reasonable success amongst these professionals. The prescription (an UN/EDIFACT message) was electronically sent to the pharmacy.
• SEH:
• CVA:
• Peri:
• JGZ:
• Palga:
• Referral/discharge to referrer:
• Diabetics:
• e-Lab:

The following projects were created (or initiated) by organizations other than NICTIZ, with the intent that the workflows and HL7 v3 artefacts be communicated using the AORTA infrastructure:

• Radiology: Radiology report, and the ability to query for key images.
• WMO:
• Care
• Prica-GGZ:
• DigiBOB: Radiology reports created as a result of a nationwide mammography screening program, and the ability for the receiver to get hold of key images.

Use of HL7 v3

All exchanges of data between components of the architecture are based on HL7 version 3. The specifications (both for the architecture as well as the HL7 v3 messages) have been mostly published in a bi-annual cycle. The HL7 messages are mostly based on the March 2004 Development Edition (a.k.a. Ballot 7); parts of later specifications have been pre-adopted and included in the AORTA specifications. In 2008/2009 a major new version of the HL7 v3 specifications will be published based upon the then-latest Normative Edition. For the actual HL7 v3 specification, see AORTA HL7 v3 Specifications (in Dutch)

HL7 Domains that are used heavily in the implementation include:

• Person Registry (BSN)
• Provider Registry (Persons and Organizations)
• Shared Messages "Act Reference" Topic
• Pharmacy/Medication (EMD)
• Patient Care (WDH, perinatology, dialysis)

..as well as infrastuctural domains such as Data Types, Transmission and Trigger Event Control Act wrappers.

In principle all interactions (and other artefacts) that are used in the implementation are based on the universal HL7 v3 standard. On occasion models have been pre-adopted (i.e. extensions have been included in interactions prior to those extensions being approved by a committee). All extensions will be turned into proposals and (ultimately) into extensions of the universal standard. This has lead to quite a number of proposals for the domains listed above.

References

• See www.ringholm.de/docs/00950_en.htm for additional information on the use of HL7 v3 Act Reference Registries.
• See www.nictiz.nl for detailted documentation of AORTA.